Impact of integrated home care services on hospital use.

OBJECTIVE

To examine the effect of a home care program based on comprehensive geriatric assessment and case management on hospital use and costs among frail older individuals.

DESIGN

Quasi-experimental study with a 6-month follow-up.

SETTING

Vittorio Veneto, a town in northern Italy.

PARTICIPANTS

One hundred fifteen frail older people who applied for integrated home care services.

INTERVENTION

Each patient was assessed with the Minimum Data Set for Home Care, and, subsequently, a case manager and a multidisciplinary team delivered social and health care services as indicated.

MAIN OUTCOME MEASURES

We determined the hospital admissions and days spent in the hospital for all subjects during the first 6 months after the implementation of the home care program and compared them with the rate of hospitalization that the same patients had experienced in the 6 months preceding the implementation of the program.

RESULTS

After the implementation of the integrated home care program, there was a significant reduction in the number of hospitalizations compared with pre-implementation (56% vs 46%, respectively; P < .001), associated with a reduction in the number of hospital days, both at the individual patient level (28+/-23 days vs 18+/-15 days, respectively; P < .01) and for each admission (16+/-12 days vs 12+/-8 days, respectively; P < .01). This resulted in a 29% cost reduction with an estimated savings of $1260 per patient.

CONCLUSIONS

The implementation of an integrated home care program based on the use of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost-effective.